Low Back Pain in Hockey Players: Why the Skating Posture Loads the Spine

Ask a room full of hockey players whether their back has ever bothered them and most hands go up. Low back pain is one of the most common complaints in the sport, from minor hockey through to beer league. Players tend to assume it means something is wrong with the spine itself. More often, it reflects how the skating position distributes load, and how little the hips and upper back are contributing.

This post explains the mechanics in plain terms and lays out what sensible management looks like.

The skating position, mechanically

Efficient skating demands a deep crouch: knees bent to around 90 degrees, hips flexed, trunk pitched forward over the skates. From that position the player drives each leg out and back in a long, powerful stride, then recovers it underneath the body. The position is held for a 45-second shift, released on the bench, then held again, dozens of times a game.

Three things happen to the low back in that posture.

First, the trunk is flexed forward and held there. The spinal extensors (the muscles along either side of the spine) work isometrically to stop the torso falling further, and they do it for long stretches without a break. Sustained, low-level muscle work with limited blood flow is a reliable recipe for a dull, aching back.

Second, the hips are flexed deeply and repeatedly. If hip flexion is limited by stiffness or by the shape of the joint, the pelvis tips backward to find the extra range, and the lumbar spine flexes further to compensate. Biomechanical studies of the hockey sprint start have described exactly this: deep hip flexion combined with trunk flexion and rotation, placing the hip and lumbar spine in positions that stress both.¹

Third, shooting and passing add rotation. A slap shot or hard wrist shot is a whole-body rotation that should come mostly from the hips and thoracic spine. When those segments are stiff, the lumbar spine, which is built for only a few degrees of rotation per segment, picks up the slack.

Why the hips are usually part of the story

Hockey players have unusually high rates of hip problems, including femoroacetabular impingement (FAI) and labral tears. In a study of NHL players, intra-articular hip injuries were common enough to be considered a sport-specific concern.² Years of skating in deep hip flexion from a young age appear to shape how the hip develops.

When a hip does not flex well, something else has to. Usually that is the low back. This is the practical meaning of regional interdependence: the painful area is often compensating for a less painful one. We have described the general principle in our post on looking beyond where it hurts, and hockey is one of the clearest examples we see.

The same logic applies to the groin. Hockey players with weaker adductors relative to their abductors have been shown to be more likely to strain the groin,³ and groin and back symptoms often travel together because both stem from the same demand on the hip.

What this does not mean

It does not mean skating is bad for your back. The position is the sport. Players who skate all season without back pain are not doing a different movement; their tissues have adapted to tolerate it.

It also does not usually mean a disc is damaged. Imaging studies of people with no back pain at all find disc bulges and degenerative changes in a large proportion of them, rising with age.⁴ In a 20-year-old with aching after games, the chance that an MRI changes the plan is small. We covered when imaging actually helps in a separate post on disc herniation and imaging.

And it does not mean the answer is more planks. Trunk endurance matters, but the players who struggle most are usually the ones whose hips and thoracic spine are not pulling their weight.

What sensible management looks like

The first question is always what changed. Back pain that arrives in the first few weeks of the season often follows a sharp jump in ice time after a summer of dryland or nothing at all. Tissue adapts to load over weeks, not days. Gabbett's work on the training-injury paradox makes the point that the problem is rarely the load itself, it is how fast it arrived.⁵

From there, a thorough assessment looks at the hips (flexion, internal rotation, and strength), the thoracic spine (rotation and extension), and how the player actually moves through a squat and a lunge. It also looks at the back, but with the understanding that the back is often the messenger.

Treatment for most players combines hands-on care for short-term relief with a progressive strength and mobility program aimed at the hips and trunk. Hip flexion and rotation drills, loaded hinge patterns, split squats, and thoracic rotation work show up in most programs. Playing through a tolerable level of discomfort is usually fine and often helpful. If you are a player or parent wondering what that assessment involves, our page on how we approach back pain describes it.

Red flags are rare in this population but worth naming: pain that wakes a player at night and does not ease with position change, numbness or weakness in a leg, any change in bladder or bowel function, or back pain following a significant fall. In adolescents, pain that is clearly worse with arching the back and persists for weeks deserves a specific look, because stress injuries to the pars interarticularis are more common in young athletes than in adults.

The takeaway

Hockey loads the low back in a specific, predictable way, and most back pain in players is the spine doing more than its share because the hips and upper back are doing less. Fix the distribution of work, build the load gradually, and the back usually settles.

References

1. Stull JD, Philippon MJ, LaPrade RF. "At-risk" positioning and hip biomechanics of the Peewee ice hockey sprint start. Am J Sports Med. 2011;39(Suppl 1):29S-35S.
2. Epstein DM, McHugh M, Yorio M, Neri B. Intra-articular hip injuries in National Hockey League players: a descriptive epidemiological study. Am J Sports Med. 2013;41(2):343-348.
3. Tyler TF, Nicholas SJ, Campbell RJ, McHugh MP. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 2001;29(2):124-128.
4. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.
5. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.